RESUMEN
PURPOSE: The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS: Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS: During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION: The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.
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Hernia Ventral , Insuflación , Neumoperitoneo , Estudios de Cohortes , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Humanos , Persona de Mediana Edad , Neumoperitoneo/cirugía , Neumoperitoneo Artificial/efectos adversos , Neumoperitoneo Artificial/métodos , Cuidados Preoperatorios/métodos , Estudios RetrospectivosRESUMEN
Background: Increased intra-abdominal pressure resulting from pneumoperitoneum can cause renal physiological changes, such as oliguria and anuria, in mammals. Although videolaparoscopic operations are common, the occurrence of renal lesions due to these procedures has not been precisely documented in the literature. The aim of this study was to evaluate the impact of pneumoperitoneum on renal blood flow using renal scintigraphy in a rabbit model. Methods: Six New Zealand male rabbits weighing 3 kg, previously anesthetized, were mechanically ventilated and underwent pneumoperitoneum. Each animal served as its own control and was analyzed in two different moments: [99mTc] diethylenetriaminepentaacetic acid (DTPA) renal blood flow evaluation in baseline conditions (T0) and 30 minutes after installation of 15 mmHg-pneumoperitoneum (T1). The animals were monitored throughout the study by capnography, oximetry, and arterial pressure median, and were euthanized at the end of the experiment. Results: The quantitative analysis of the scintigraphic images of renal uptake of the radiopharmaceutical evidence reduced renal arterial blood flow during pneumoperitoneum. Compared with baseline conditions, all animals presented a reduction of renal blood flow varying from 16% to 82%, with mean [±standard deviation] of 53% [±24%]. Conclusions: Pneumoperitoneum induces a significant reduction of the renal blood flow, as determined in this experimental method in rabbits and dynamic renal scintigraphy with [99mTc] DTPA is an adequate method to investigate this event in the experimental setting.
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Riñón/diagnóstico por imagen , Neumoperitoneo Artificial/efectos adversos , Circulación Renal/fisiología , Animales , Riñón/irrigación sanguínea , Pruebas de Función Renal , Masculino , Conejos , Cintigrafía , Radiofármacos , Pentetato de Tecnecio Tc 99mRESUMEN
BACKGROUND: Repair of hernias with loss of domain in obese patients can lead to acute respiratory failure. OBJECTIVES: The objective of this study was to analyze preoperative progressive pneumoperitoneum (PPP) in increasing abdominal cavity volume and its impact on respiratory function. SETTING: The study was conducted at the University Hospital, State University of Londrina, Brazil, which is a referral center for the treatment of obesity. The patients were hospitalized for the duration of the study. METHODS: Sixteen obese patients were evaluated. Computed tomography was used to determine hernia sac volume (HSV) and abdominal cavity volume (ACV). Respiratory function was evaluated by measuring vital capacity and forced expiratory volume in the first second (FEV-1). All data were obtained before PPP, on the day before surgery, and on the second postoperative day. PPP was performed daily with insufflation of CO2. RESULTS: The number of insufflations was 12. The average of total volume inflated was 5.7 L. The HSV was 2953 cm3 before PPP and 1935 cm3 after PPP. The average ACV increased from 8898 to 11,317 cm3 after PPP. The relationship between HSV and ACV was 38.2% before and 16.3% after PPP. There was a favorable improvement in respiratory function with an increase in vital capacity from 1875 to 2760 mL and an increase in FEV-1 from 1060 to 1670 mL after PPP. Respiratory function tests after surgery showed values of 2600 and 1560 mL, respectively, for cavity volume and FEV-1. There were no postoperative respiratory complications. CONCLUSIONS: This technique can be used safely in the surgical preparation of obese patients with hernias with loss of domain, reducing the relation between HSV and ACV and avoiding pulmonary complications.
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Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/cirugía , Herniorrafia/métodos , Obesidad Mórbida/diagnóstico , Neumoperitoneo Artificial/métodos , Insuficiencia Respiratoria/etiología , Adulto , Brasil , Estudios de Cohortes , Femenino , Herniorrafia/efectos adversos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neumoperitoneo Artificial/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios/métodos , Pronóstico , Pruebas de Función Respiratoria , Insuficiencia Respiratoria/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Mallas Quirúrgicas/estadística & datos numéricos , Resultado del TratamientoRESUMEN
BACKGROUND: Laparoscopic surgery has begun to replace a great number of procedures that were previously practiced using open or conventional techniques. This is due to the minimal invasion, small incisions, and short time recovery. However, it has come to knowledge, that the increase in intra-abdominal pressure due to carbon dioxide pneumoperitoneum during laparoscopic surgery causes cardiovascular, respiratory, endocrine, and renal alterations. OBJECTIVE: To evaluate the nephroprotective effect of telmisartan, an angiotensin II AT1 receptor antagonist, on glomerular filtration in laparoscopic surgery. MATERIAL AND METHODS: Analytical prospective, randomised, double-blind study was conducted on patients undergoing elective laparoscopic cholecystectomy. They were randomised into 2 groups, with the treatment group receiving a single dose of 40mg telmisartan orally 2hours prior to surgery, and the placebo group. RESULTS: There were 20 patients in each group (n=40), with a mean age of 32.65 years in the treatment group. Plasma creatinine did not show any significant change in the different time lapse in which blood samples were taken, but creatinine clearance at the end of surgery (196.415±56.507 vs. 150.1995±75.081; p=0.034), and at 2 h postoperative period (162.105±44.756 vs. 113.235±31.228; p≤0.001) was statistically significant, which supports an increase in renal function in the telmisartan group. CONCLUSION: The use of telmisartan, an angiotensin II AT1 receptor antagonist, offers renal protection during laparoscopic surgery.
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Lesión Renal Aguda/prevención & control , Bloqueadores del Receptor Tipo 1 de Angiotensina II/farmacología , Bencimidazoles/farmacología , Benzoatos/farmacología , Colecistectomía Laparoscópica , Tasa de Filtración Glomerular/efectos de los fármacos , Complicaciones Intraoperatorias/prevención & control , Neumoperitoneo Artificial/efectos adversos , Acidosis Respiratoria/etiología , Lesión Renal Aguda/tratamiento farmacológico , Lesión Renal Aguda/etiología , Adulto , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Bencimidazoles/uso terapéutico , Benzoatos/uso terapéutico , Biomarcadores , Dióxido de Carbono/administración & dosificación , Dióxido de Carbono/efectos adversos , Creatinina/sangre , Método Doble Ciego , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Insuflación , Complicaciones Intraoperatorias/tratamiento farmacológico , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Telmisartán , Adulto JovenRESUMEN
PURPOSE:: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS:: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS:: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION:: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.
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Anticoagulantes/uso terapéutico , Dióxido de Carbono/efectos adversos , Enoxaparina/uso terapéutico , Hígado/efectos de los fármacos , Oxígeno/administración & dosificación , Neumoperitoneo Artificial/efectos adversos , Animales , Dióxido de Carbono/administración & dosificación , Modelos Animales de Enfermedad , Femenino , Hígado/patología , Estrés Oxidativo/fisiología , Neumoperitoneo Artificial/métodos , Presión , Ratas , Ratas Wistar , Tromboembolia/prevención & controlRESUMEN
ABSTRACT PURPOSE: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.
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Animales , Femenino , Ratas , Oxígeno/administración & dosificación , Neumoperitoneo Artificial/efectos adversos , Dióxido de Carbono/efectos adversos , Enoxaparina/uso terapéutico , Hígado/efectos de los fármacos , Anticoagulantes/uso terapéutico , Neumoperitoneo Artificial/métodos , Presión , Tromboembolia/prevención & control , Dióxido de Carbono/administración & dosificación , Ratas Wistar , Estrés Oxidativo/fisiología , Modelos Animales de Enfermedad , Hígado/patologíaRESUMEN
BACKGROUND: The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. PATIENTS AND METHODS: Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. EXCLUSION CRITERIA: The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. RESULTS: (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well. CONCLUSION: We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.
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Posicionamiento del Paciente/métodos , Neumoperitoneo Artificial/métodos , Presión , Prostatectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Análisis de Varianza , Presión Arterial , Biomarcadores/sangre , Análisis de los Gases de la Sangre , Gasto Cardíaco , Inclinación de Cabeza , Hemodinámica , Humanos , Isquemia/etiología , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente/efectos adversos , Neumoperitoneo Artificial/efectos adversos , Prostatectomía/efectos adversos , Valores de Referencia , Procedimientos Quirúrgicos Robotizados/efectos adversos , Albúmina Sérica , Albúmina Sérica Humana , Circulación Esplácnica , Factores de TiempoRESUMEN
ABSTRACT Background The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) ...
Asunto(s)
Humanos , Masculino , Anciano , Neumoperitoneo Artificial/métodos , Presión , Prostatectomía/métodos , Posicionamiento del Paciente/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neumoperitoneo Artificial/efectos adversos , Prostatectomía/efectos adversos , Valores de Referencia , Circulación Esplácnica , Factores de Tiempo , Análisis de los Gases de la Sangre , Albúmina Sérica , Gasto Cardíaco , Biomarcadores/sangre , Análisis de Varianza , Laparoscopía/métodos , Inclinación de Cabeza , Posicionamiento del Paciente/efectos adversos , Presión Arterial , Procedimientos Quirúrgicos Robotizados/efectos adversos , Albúmina Sérica Humana , Hemodinámica , Isquemia/etiología , Persona de Mediana EdadRESUMEN
PURPOSE: To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS: Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS: The CO2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS: The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.
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Dióxido de Carbono/administración & dosificación , Helio/administración & dosificación , Neumoperitoneo Artificial/métodos , Animales , Dióxido de Carbono/efectos adversos , Creatinina/sangre , Helio/efectos adversos , Riñón/efectos de los fármacos , Riñón/fisiología , Pruebas de Función Renal , Masculino , Modelos Animales , Neumoperitoneo Artificial/efectos adversos , Distribución Aleatoria , Ratas , Ratas Wistar , Sodio/sangre , Factores de Tiempo , Urea/sangre , Micción/fisiologíaRESUMEN
PURPOSE: To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS: Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS: The CO2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS: The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.
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Animales , Masculino , Ratas , Dióxido de Carbono/administración & dosificación , Helio/administración & dosificación , Neumoperitoneo Artificial/métodos , Dióxido de Carbono/efectos adversos , Creatinina/sangre , Helio/efectos adversos , Pruebas de Función Renal , Riñón/efectos de los fármacos , Riñón/fisiología , Modelos Animales , Neumoperitoneo Artificial/efectos adversos , Distribución Aleatoria , Ratas Wistar , Sodio/sangre , Factores de Tiempo , Urea/sangre , Micción/fisiologíaRESUMEN
PURPOSE: To investigate the seminiferous tubule histological morphology after an 8 mmHg pneumoperitoneum in the rat model. METHODS: Fourteen rats were divided into two groups: a Sham group submitted to anesthesia and a pneumoperitoneum (Pp) group submitted to abdominal insufflation at 8 mmHg during three hours, followed by desuflation. All rats were killed after six weeks, testicles were collected and evaluated for the tubule diameter, germinative epithelium height and Johnsen´s score. Means were compared by using the Student's-t-test. RESULTS: The seminiferous tubule diameter was diminished by 11.3% in the group submitted to pneumoperitoneum (p<0.05). No significant difference was found among the groups when analyzing the epithelium height and Johnsen´s score. CONCLUSION: In the rat model, the seminiferous tubules present structural alterations when subjected to pneumoperitoneum of 8 mmHg during three hours.
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Neumoperitoneo Artificial/efectos adversos , Testículo/patología , Animales , Masculino , Modelos Animales , Tamaño de los Órganos , Distribución Aleatoria , Ratas , Ratas Wistar , Factores de TiempoRESUMEN
INTRODUCTION: Neuraxial anesthesia in upper abdominal laparoscopic surgery decreases perioperative morbidity and mortality. However, shoulder pain is common and difficult to control. Use of a major opioid (e.g., fentanyl) for the control of this event may depress respiratory function. This is why we believe that a safe and effective therapeutic control of this disease pain is a multimodal analgesic scheme which we have called infusional therapy. OBJECTIVE: To compare various schemes for controlling shoulder pain secondary to pneumoperitoneum. METHODS: Nonrandomized clinical trial with 56 patients ASA I-II divided into four groups undergoing laparoscopic cholecystectomy. Group I (n= 15) managed with ketorolac 1 mg kg, group II (n = 12) ketoprofen 100 mg, group III (n = 14) ketoprofen 50 mg + 50 mg tramadol, and group IV (n = 15) ketoprofen 100 mg + 100 mg tramadol. The following ariables were analyzed: presence and intensity of pain, analgesia rescue and operative time. RESULTS: Group I had more shoulder pain events compared to other groups (p= 0.002) in the same way the group IV required less rescue analgesia (p= 0.034). CONCLUSION: preemptive analgesia to infusional therapy with ketoprofen-tramadol at doses of 100 mg each is safe for laparoscopic surgery.
Antecedentes: en cirugía laparoscópica del hemiabdomen superior la anestesia neuroaxial disminuye la morbilidad y mortalidad perioperatorias; sin embargo, el dolor de hombro es una afección frecuente de difícil control. Puesto que los fármacos opioides mayores (fentanilo) para el control del dolor deprimen la función respiratoria, consideramos que la terapia infusional es un tratamiento seguro y eficaz. Objetivo: comparar diversos esquemas analgésicos para el control del dolor de hombro secundario al neumoperitoneo. Material y método: ensayo clínico no aleatorizado, efectuado en 56 pacientes ASA I-II en cuatro grupos con colecistectomía laparoscópica. El grupo I (n= 15) se trató con ketorolaco 1 mg/kg, el grupo II (n= 12) con ketoprofeno 100 mg, el grupo III (n= 14) con ketoprofeno 50 mg más tramadol 50 mg, y el grupo IV (n= 15) con ketoprofeno 100 mg más tramadol 100 mg. Las variables analizadas fueron: dolor y su intensidad, analgesia de rescate y tiempo quirúrgico. Resultados: en el grupo I hubo más episodios de dolor de hombro que en el resto de los grupos (p= 0.002); el grupo IV requirió menos analgesia de rescate (p= 0.034). Conclusión: la analgesia preventiva con terapia infusional con ketoprofeno-tramadol, a dosis de 100 mg, es segura para pacientes intervenidos mediante cirugía laparoscópica.
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Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Colecistectomía Laparoscópica , Cetoprofeno/uso terapéutico , Ketorolaco/uso terapéutico , Bloqueo Nervioso/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Medicación Preanestésica , Dolor de Hombro/tratamiento farmacológico , Tramadol/uso terapéutico , Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Quimioterapia Combinada , Femenino , Fentanilo/uso terapéutico , Humanos , Bombas de Infusión , Infusiones Intravenosas , Cetoprofeno/administración & dosificación , Ketorolaco/administración & dosificación , Masculino , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Neumoperitoneo Artificial/efectos adversos , Trastornos Respiratorios/prevención & control , Dolor de Hombro/etiología , Dolor de Hombro/prevención & control , Factores de Tiempo , Tramadol/administración & dosificaciónRESUMEN
PURPOSE:To investigate the seminiferous tubule histological morphology after an 8 mmHg pneumoperitoneum in the rat model. METHODS: Fourteen rats were divided into two groups: a Sham group submitted to anesthesia and a pneumoperitoneum (Pp) group submitted to abdominal insufflation at 8 mmHg during three hours, followed by desuflation. All rats were killed after six weeks, testicles were collected and evaluated for the tubule diameter, germinative epithelium height and Johnsen´s score. Means were compared by using the Student's-t-test. RESULTS:The seminiferous tubule diameter was diminished by 11.3% in the group submitted to pneumoperitoneum (p<0.05). No significant difference was found among the groups when analyzing the epithelium height and Johnsen´s score. CONCLUSION:In the rat model, the seminiferous tubules present structural alterations when subjected to pneumoperitoneum of 8 mmHg during three hours.
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Animales , Masculino , Ratas , Neumoperitoneo Artificial/efectos adversos , Testículo/patología , Modelos Animales , Tamaño de los Órganos , Distribución Aleatoria , Ratas Wistar , Factores de TiempoRESUMEN
PURPOSE: Pneumoperitoneum (Pp) at 12 to 15 mmHg in rats is associated with kidney damage. However, Pp at 8 mmHg is now known to best correlate to working pressures used in humans. Thus the aim of this work was to study the kidney of rats submitted to prolonged Pp at 8 mmHg. MATERIALS AND METHODS: Rats were divided into a Sham group (n = 14), submitted to anesthesia, and a Pp group (n = 14), submitted to Pp at 8 mmHg, followed by deflation. In both groups, 7 animals were immediately killed and their kidneys were used for oxidative stress analyses. The remaining 7 rats in each group were evaluated after 6 weeks for the number of glomeruli and podocyte morphology. RESULTS: For all analyzed parameters Sham and Pp groups presented no statistical difference. CONCLUSION: When submitted to adequate Pp pressures (8 mmHg), no kidney damage occurs in rats.
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Riñón/lesiones , Estrés Oxidativo , Neumoperitoneo Artificial/efectos adversos , Presión/efectos adversos , Animales , Riñón/patología , Masculino , Malondialdehído/análisis , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Modelos Animales , Tamaño de los Órganos , Distribución Aleatoria , Ratas , Ratas Wistar , Valores de Referencia , Factores de TiempoRESUMEN
Purpose: Pneumoperitoneum (Pp) at 12 to 15 mmHg in rats is associated with kidney damage. However, Pp at 8 mmHg is now known to best correlate to working pressures used in humans. Thus the aim of this work was to study the kidney of rats submitted to prolonged Pp at 8 mmHg. Materials and Methods: Rats were divided into a Sham group (n = 14), submitted to anesthesia, and a Pp group (n = 14), submitted to Pp at 8 mmHg, followed by deflation. In both groups, 7 animals were immediately killed and their kidneys were used for oxidative stress analyses. The remaining 7 rats in each group were evaluated after 6 weeks for the number of glomeruli and podocyte morphology. Results: For all analyzed parameters Sham and Pp groups presented no statistical difference. Conclusion: When submitted to adequate Pp pressures (8 mmHg), no kidney damage occurs in rats. .
Asunto(s)
Animales , Masculino , Ratas , Riñón/lesiones , Estrés Oxidativo , Neumoperitoneo Artificial/efectos adversos , Presión/efectos adversos , Riñón/patología , Microscopía Electrónica de Rastreo , Microscopía Electrónica de Transmisión , Modelos Animales , Malondialdehído/análisis , Tamaño de los Órganos , Distribución Aleatoria , Ratas Wistar , Valores de Referencia , Factores de TiempoRESUMEN
BACKGROUND: Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management. OBJECTIVE: The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment. METHODS: We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period. CONTROL GROUP: one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia. RESULTS: Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001). CONCLUSION: 250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.
Antecedentes: la colecistectomía laparoscópica es el patrón de referencia del tratamiento de la colelitiasis sintomática. El 63% de los pacientes operados sufre dolor postquirúrgico referido al hombro (omalgia), circunstancia que limita el tratamiento ambulatorio. Objetivo: evaluar la utilidad de la acetazolamida asociada con ketorolaco para disminuir la omalgia consecutiva al tratamiento de mínima invasión. Material y métodos: ensayo clínico, aleatorizado, doble ciego realizado en pacientes a quienes se efectuó colecistectomía laparoscópica para evaluar la reducción de la omalgia postoperatoria y comparar el efecto de ketorolaco y ketorolaco más acetazolamida. En cada grupo se estudiaron 31 pacientes. El grupo de estudio recibió 250 mg de acetazolamida antes de la inducción anestésica, y 30 mg de ketorolaco en el postoperatorio inmediato. El grupo control recibió una tableta de placebo antes de la inducción anestésica, y 30 mg de ketorolaco en el postoperatorio inmediato. La omalgia se evaluó con la escala visual análoga. Las variables estudiadas incluyeron: edad, sexo, flujo de dióxido de carbono, presión intrabdominal, tiempo quirúrgico, cirugía electiva o urgente, omalgia, intensidad del dolor evaluada con la escala visual análoga y analgesia de rescate. Resultados: los grupos estudiados fueron homogéneos, el análisis estadístico no mostró diferencias en las variables estudiadas. En el grupo de estudio la omalgia coexistió en 9.67% de los pacientes y en el grupo control en 58.06% (p < 0.001). Conclusión: la administración por vía oral de 250 mg de acetazolamida y 30 mg de ketorolaco redujo significativamente la omalgia en los pacientes a quienes se realizó colecistectomía laparoscópica.
Asunto(s)
Acetazolamida/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Inhibidores de Anhidrasa Carbónica/uso terapéutico , Colecistectomía Laparoscópica , Ketorolaco/uso terapéutico , Dolor Postoperatorio/prevención & control , Dolor Referido/prevención & control , Neumoperitoneo Artificial/efectos adversos , Medicación Preanestésica , Dolor de Hombro/prevención & control , Acetazolamida/administración & dosificación , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Dióxido de Carbono/administración & dosificación , Dióxido de Carbono/farmacocinética , Inhibidores de Anhidrasa Carbónica/administración & dosificación , Colelitiasis/epidemiología , Colelitiasis/cirugía , Quimioterapia Combinada , Femenino , Humanos , Ketorolaco/administración & dosificación , Masculino , México/epidemiología , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Dolor Referido/tratamiento farmacológico , Dolor Referido/etiología , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/etiologíaRESUMEN
The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.
Asunto(s)
Apendicectomía , Enfermedades del Íleon/etiología , Vólvulo Intestinal/etiología , Laparoscopía , Complicaciones Posoperatorias/etiología , Adolescente , Anestésicos/efectos adversos , Apendicectomía/efectos adversos , Apendicitis/complicaciones , Apendicitis/cirugía , Humanos , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Íleon/irrigación sanguínea , Íleon/patología , Vólvulo Intestinal/cirugía , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Laparoscopía/efectos adversos , Masculino , Necrosis , Neumoperitoneo Artificial/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: Elevations of intraabdominal pressure during laparoscopic procedures may lead to oliguria or anuria in mammals. Despite this, previous research has not been able to confirm an associated kidney injury. This study aimed to investigate the occurrence of an early kidney lesion secondary to surgical pneumoperitoneum in a rat model using the expression of neutrophil gelatinase-associated lipocalin (N-GAL) as a biomarker for early kidney injury. METHODS: In this study, 20 male Sprague-Dawley rats under general anesthesia and mechanically ventilated were allocated to one of five experimental time-dependent groups: group 1 (1-h control), group 2 (1-h pneumoperitoneum), group 3 (2-h control), group 4 (2-h pneumoperitoneum), and group 5 (positive kidney injury group induced by intravenous administration of cisplatin 7.5 mg/kg). To evaluate the renal expression of N-GAL 24 h after the procedure, all the rats underwent a 2-h urine output evaluation as well as laparotomy and bilateral nephrectomy performed sequentially to investigate the presence of renal injury using immunofluorescence qualification and western blotting. RESULTS: Urine output was reduced and N-GAL expression was increased in the animals from the cisplatin group. The animals undergoing 1- or 2-h pneumoperitoneum displayed urine output and N-GAL expression similar to that of the animals from the matching control groups. CONCLUSIONS: Under the experimental conditions of this study, the animals with normal preoperative renal function did not show any type of acute kidney injury associated with the presence of a stabilized surgical pneumoperitoneum.
Asunto(s)
Lesión Renal Aguda/etiología , Neumoperitoneo Artificial/efectos adversos , Lesión Renal Aguda/metabolismo , Proteínas de Fase Aguda/análisis , Proteínas de Fase Aguda/biosíntesis , Animales , Biomarcadores/análisis , Lipocalina 2 , Lipocalinas/análisis , Lipocalinas/biosíntesis , Masculino , Proteínas Proto-Oncogénicas/análisis , Proteínas Proto-Oncogénicas/biosíntesis , Ratas , Ratas Wistar , OrinaRESUMEN
The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.
Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.
Asunto(s)
Humanos , Masculino , Adolescente , Apendicectomía , Enfermedades del Íleon/etiología , Vólvulo Intestinal/etiología , Laparoscopía , Complicaciones Posoperatorias/etiología , Anestésicos/efectos adversos , Apendicectomía/efectos adversos , Apendicitis/complicaciones , Apendicitis/cirugía , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Íleon/irrigación sanguínea , Íleon/patología , Vólvulo Intestinal/cirugía , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Laparoscopía/efectos adversos , Necrosis , Neumoperitoneo Artificial/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: In prolonged laparoscopic procedures, hypothermia is frequently observed. The possible influence of the vasodilating action of CO(2), due to its increased levels in the blood during the laparoscopic procedures, has yet to be studied. The objective of this study was, therefore, to evaluate body temperature patterns in pigs subjected to pneumoperitoneum with CO(2). METHODS: Thirty male pigs were allocated into three groups of ten animals each: group I, anesthetic procedure and abdominal puncture only; group II, the same as for group I and insufflation with CO(2); and group III, the same as for group I and insufflation with medical grade compressed air. After anesthetic induction and surgical preparation, rectal and esophageal temperatures were measured every 10 min. Blood was collected during the experiment for the gasometric measurement of pCO(2). Animals were insufflated with no gas loss and were kept anesthetized for 180 min. For statistical analysis, Friedman and Kruskal-Wallis tests were used at a level of significance of 95% (P < 0.05). RESULTS: Animals in groups I and II (P = 0.000) had a statistically significant drop in both esophageal and rectal temperatures during the experiment, but not animals in group III. However, when the groups were compared among themselves, no statistically significant differences were found at any of the times measured. A statistically significant drop in pCO(2) levels was observed for groups I and III, but not for animals in groups II. CONCLUSIONS: The use of CO(2) did not significantly affect body temperature variation in pigs subjected to pneumoperitoneum. However, CO(2) produced a temperature drop pattern different than that of compressed air, indicating that CO(2) may lead to thermoregulatory changes and influence the peripheral temperature drop.